Improving Access to Healthier Foods for Individuals with Intellectual Disabilities Living in Home Care Settings through Model Food Service Guidelines Angela Amico, MPH Senior Policy Associate aamico@cspinet.org @CSPI, @angela__amico cspinet.org
Presenter Disclosures Angela Amico The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No Relationships to Disclose Funding Disclosure: Work supported by Inclusive Health Innovation Grant, Special Olympics
Center for Science in the Public Interest • Since 1971, CSPI mission: • Make it easier to eat healthfully • Prevent/mitigate diet‐ and obesity‐related diseases • What do we do? • Empower consumers to identify and choose healthier options • Safeguard food supply • Transform the food environment to support healthier eating • How do we do it? • National, state and local policy • Corporate engagement • Litigation • Consumer education
Nutrition Recommendations
Our Actual Food Environment
Why Healthier Public Places? • Model and reinforce other nutrition and obesity prevention efforts • Increase demand for healthier foods and beverages • Encourage product reformulation • Reduce prevalence of obesity, diabetes, heart disease, and diet‐ related diseases • Reduce health care costs
Good Food Transforms the Food System Policy Increase Demand Reset Shift Industry Increased Practices supply
Growing Movement Adopted Food Service Guideline Policies State County City Other
Comprehensive Guidelines Benefit Communities • Parks and Recreation • Convention Centers • Office Buildings • Libraries • Senior Centers • Schools and Universities • Hospitals • Correctional Facilities
Special Olympics Center for Inclusive Health
Understanding Group Home Practices Worked with American Network of Community Options and Resources (ANCOR), which represents more than 1,400 community providers Interviewed and surveyed service providers for adults with intellectual disabilities
Intellectual and Developmental Disabilities Developmental Disability: broad term to encompass both physical and intellectual disability Intellectual (Cognitive) Disability: • Intellectual functioning level (IQ) below 70‐75 • Significant limitations in adaptative skills • Condition present from childhood
Dietary Considerations Table showing food and liquid texture modifications
Health Disparities Adults with intellectual disability are: • 5x > diabetes • 2x > heart disease • Higher risk for obesity Krahn, G.L. & Fox, M.H. (2014). Health disparities of adults with intellectual disabilities: what do we know? What do we do? J Appl Res Intellect Disabil. 27(5), 431‐46.
Group Homes Intermediate care facilities: optional Medicaid benefit, offered by all states • Higher level of care (active treatment required) • Comprehensive services: room and board Medicaid 1915(c) Home and Community‐based Services Waiver established 1981 • Community integration 2014, focus on individual • Typically lower level of care • Can include meal services
Group Homes • Several group homes may be managed by same organization • <10 residents, many <5 residents • Not all group homes have dietitian (varies by intermediate care facility and community options) Image Source: Fairfield City Champion
Example of two week sample menu
Common Dietary Modifications • Nutrition • Reduced calorie • Reduced sodium • Reduced sugar • Reduced serving amount • Reduced fat • Other • Medication • Modified texture • Thickened liquids • Adaptive eating equipment • Allergens and preferences
General Guidelines • Fruits and vegetables • Whole grains • Calories • Sugar • Sodium • Saturated fat
Meal Planning Resources • Government resources (e.g. MyPlate) and online recipes • Meals may be planned by third party • Food vendor • Dietitian • Majority did not work with private program or company for assistance developing menus, some do • Services can be comprehensive, including shopping lists and incentives • Cost can be barrier
Food Shopping • Grocery lists developed by dietitians, group home staff, individuals supported • Individuals supported to add items to grocery list • Food Sources: • Grocery stores • Food distributers (Sysco) • Central kitchens
Food Shopping • Shopping by service providers, individuals supported, food/nutrition staff (dietitian, chef, food service supervisor) • Daily Food Budget • $4.75‐ $60 • Based on number of individuals in home and dietary needs
Food Preparation • By staff members, with some potential involvement from individuals supported • Staff preparing food have some training (e.g. safe food handling) • May not have received culinary training or have other responsibilities in the home • Some homes have specific food preparation staff
Food Preparation • Scratch cooking • Combination of prepared foods and scratch cooked items • Pre‐prepared foods (e.g. frozen entrees) • Staff do not always follow recipes • Lack of culinary training • Shortcuts (substituting processed or pre‐prepared items) • Wrong ingredients purchased or missing ingredients • Staff preference for certain dishes • Individuals supported recipe preferences
Staff Participation Staff: • Eat for free with individuals supported • Choose not to eat with individuals supported • Pay to eat with individuals supported • Eat their own food while serving meals to individuals supported
Acceptability • General acceptability • Preference for meals made by certain staff members • Few regular complaints • Individual variation (some picky eaters, some who generally like everything) Image Source: Portland Press Herald
Food Away from Home • Packed lunches for day programs • Individual purchases at grocery stores and restaurants
Challenges • Modifications of meals makes general resources challenging • “General resources are not that helpful” • Limited time and staff training • “Any training would be helpful” • “Healthy frozen prepared meals that can be used when staffing is short or there are a lot of activities to attend to and meal preparation time is short.” • High turnover rate among providers
The Bigger Picture • Our food environment is challenging • Considering an inclusive health approach ensures better access to healthier foods for everyone
Stay Connected Join our Action Network at cspinet.org/ActNow
Inclusive Health Resources • Special Olympics Center for Inclusive Health • American Association on Intellectual and Developmental Disabilities • American Academy of Developmental Medicine and Dentistry
Food Service Guideline Resources • Fact sheets, model policies, and policy summaries available at https://bit.ly/CSPI‐FSG • Healthy Meeting Toolkit and Model Pledge available at healthymeeting.org • Food Service Guidelines Collaborative foodserviceguidelines.org • Learn about new resources and funding opportunities and network with others working on food service guidelines through our listserv • E‐mail: aamico@cspinet.org
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